Healthcare Provider Details

I. General information

NPI: 1376891739
Provider Name (Legal Business Name): STEPHEN ALLEN STANSBURY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 HWY 17
WINNSBORO LA
71295
US

IV. Provider business mailing address

203 CHADWICK DR
WEST MONROE LA
71291-9547
US

V. Phone/Fax

Practice location:
  • Phone: 318-722-3333
  • Fax:
Mailing address:
  • Phone: 318-235-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6882
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number96401
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: